Calculating the cost of medication errors: A systematic review of approaches and cost variables.

INTRODUCTION: Medication errors are an unnecessary cost to a healthcare system and patients of a country. This review aimed to systematically identify published cost variables used to calculate the cost of medication errors and to explore any updates on findings already known on calculating the cost of medication errors during the past 10 years. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases, PubMed, Scopus, Emerald and JSTOR were searched, using keywords "medication error" AND "cost" and predetermined inclusion criteria. Duplicate articles were removed. Quality check was done using 10 criteria. Cost variables used in calculating the cost of medication errors were extracted from each article. RESULTS: Among 3088 articles, 33 articles were selected for review. Most studies were conducted in Western countries. Cost variables used (types and number) by different studies varied widely. Most studies (N=29) had used direct costs only. A few studies (N=4) had used both direct and indirect costs for the purpose. Perspectives considered when calculating cost of medication errors also varied widely. A total of 35 variables used to calculate medication error costs were extracted from selected articles. CONCLUSION: Variables used to calculate the cost of medication errors were not uniform across studies. Almost a decade after systematic reviews previously reporting on this area, a validated methodology to calculate the cost of medication errors has still not been reported to date and highlights the still pending necessity of a standard method to be established.

Prescribing, dispensing and administration indicators to describe rational use of oral dosage forms of medicines given to children.

Background: Owing to lack of indicators, researchers are compelled to use non-specific indicators to assess rational use of medicines in children. Thus, paediatric-specific issues are poorly described. This study aims to develop a set of indicators to describe rational use of oral dosage forms of medicines given to children. Methods: A modified RAND/UCLA Appropriateness Method was used. A comprehensive draft list of 40 indicators was compiled, based on the results of a literature review. Twelve experts rated these indicators in two rounds, using a nine-point Likert scale, first in an online survey, for clarity, necessity and scientific merit, and secondly in a face-to-face meeting, for necessity, feasibility and predictive value. An overall panel median score of ≥7 and agreement within the experts were used in indicators. The indicators were ranked independently by the research team and a final list of indicators was prepared. These indicators were pilot-tested for acceptability and interrater reliability. Results: Nine prescribing indicators, such as weight, appropriate dose and age-appropriate dosage form; five dispensing indicators, such as adequacy of labelling and inappropriate manipulation by pharmacists; and five administration indicators, such as inappropriate manipulation by parents and full completion of dose, were finalized in the second round. Conclusion: This novel approach has provided a set of indicators to describe the use of oral dosage forms of medicines given to children, which can be used by researchers as a supplement to the World Health Organization's drug use indicators when investigating rational use of medicines in children.